WCRF/AICR

Global Network

A new study has found that adult survivors of childhood cancers who most followed AICR Recommendations for Cancer Prevention cut their risk of developing metabolic syndrome, a group of risk factors that raises the risk for heart disease and other health problems. Those who least followed the recommendations had more than double the risk of metabolic syndrome, even decades after their cancer diagnosis.

Published early online in the journal CANCER, this study strengthens the evidence that a healthy lifestyle is important for the long-term health of childhood cancer survivors, who face an increased risk of cardiovascular disease and other chronic health conditions.

The study also adds to previous research suggesting that following AICR Recommendations not only cuts cancer risk, it may prevent earlier death, help survivors and protect against other chronic diseases.

“This is excellent news for childhood cancer survivors,” said the study’s lead Kirsten Ness, PT, PhD, of St. Jude Children's Research Hospital. “They have the opportunity to impact their health is a positive way. Adopting a healthy lifestyle may reduce risk for some late effects of cancer treatment – like metabolic syndrome.”

Approximately three quarters of adults who had cancer as children will face at least one chronic health condition. Radiotherapy and other treatments along with obesity and other modifiable lifestyle factors increase the risk of metabolic syndrome. People with metabolic syndrome have some combination of factors including high blood pressure, abnormal cholesterol and glucose levels, and excess body fat. Metabolic syndrome puts people at risk for heart disease, stroke, and type 2 diabetes. Several of the conditions in metabolic syndrome also relate to increased risk of several cancers.

The study reports that metabolic syndrome ranges from 7 to 60 percent among survivors of childhood cancers. Those treated with radiation to the head, cranial radiotherapy, are at highest risk.

For the study, the researchers used questionnaires and tests from 1,598 childhood cancer survivors who were cancer-free for at least 10 years. Participants ranged in age from 19 to 60 with an average of almost 26 years passing since they were diagnosed with cancer.

Those who were identified as having three or more factors related to metabolic syndrome were classified as having the condition.

Ness and her colleagues selected the AICR recommendations to follow because they included diet, along with physical activity and smoking recommendations and because they are not too complicated for survivors to follow, she said. “Childhood cancer survivors are at risk for a second malignancy in addition to their risk for metabolic syndrome, obesity and heart disease. This scale is cancer focused.”

The study measured adherence to seven of the ten AICR Recommendations (leaving out the recommendations for special populations, supplements and sodium). The seven recommendations include staying a healthy weight; being physically active; consuming fruit and vegetables and other plant foods; limiting alchol consumption; eating below 18 ounces (80 grams a day) of red meat; and limiting sodium.

Slightly over a quarter of the participants followed four or more of AICR’s recommendations. Almost a third – 32 percent – of the participants had metabolic syndrome.

Women who follow three or fewer recommendations were 2.4 times and men were 2.2 times more likely to have metabolic syndrome than those who most followed the guidelines. The association between those making unhealthy lifestyle choices and metabolic syndrome persisted after taking into account known risk factors, including smoking, age and cranial radiotherapy.

The association between metabolic syndrome and an unhealthy lifestyle was even stronger than the association between metabolic syndrome and cranial radiotherapy, the study found, suggesting that risk is modifiable by adopting healthy lifestyle habits.

Results indicates that adults who were treated for cancer as children have the opportunity to influence their own health outcomes, said Ness. The findings make sense because “lifestyle has an effect in persons who have not been exposed to childhood cancer and its treatment. It is simply that survivors are at greater risk than peers because of their exposures… They are vulnerable and should be provided with tools that promote positive health behaviors early in the course of survivorship.”

The study was funded by Cancer Center Support from the National Cancer Institute and the American Lebanese Syrian Associated Charities.